The feather touch rasp, a powered instrument for hump reduction.

INTRODUCTION AND AIM: Standard rhinoplasty procedure involves bony profile alignment with an osteotome, followed by profile refinement with a manual rasp. The entire bony hump may sometimes be addressed with a rasp. Manual rasps and osteotomes, however, can be traumatic instruments, resulting in tissue oedema and bruising. The feather touch rasp is one of the powered instruments developed in recent years to improve precision and technical ease while preventing tissue trauma. The powered rasp has been frequently used at our department in the last eighteen months for hump reductions. MATERIAL AND METHODS: Retrospective evaluation of 72 rhinoplasty procedures performed in 68 patients between January 2004 and June 2005. A bony hump reduction was necessary in 52 of the 68 patients. 60% of the patients were male. The mean age was 30 years. The open rhinoplasty technique was used in 65% of the patients. All humps were addressed with the feather touch rasp only. Patients were seen 10 days, 4 weeks and three months after surgery. RESULTS: In one patient the nasal dorsum remained too high. We found one asymmetric nasal dorsum. Another patient had a low nasofrontal angle, creating a false impression of a remaining hump. In two patients, bony irregularities appeared a few months after the rhinoplasty procedure. Overall, most patients were satisfied with the results of the hump reduction. CONCLUSIONS: The feather touch rasp makes safe and gradual bony hump reduction possible, with fragments being aspirated and the overlying skin being well protected.

Viral rhinitis and asthma.

Upper respiratory tract infections are among the most common infectious diseases. Approximately 80% of the common colds are caused by rhinoviruses. Recently, rhinovirus colds have been linked with lower airway illnesses such as asthma exacerbations resulting in a considerable interest in the pathogenesis of lower respiratory tract pathology. The important role that allergic airway disease plays in virally induced changes in airway function has been experimentally shown in several studies. Unfortunately, the precise mechanisms by which viruses could induce lower airway symptoms have not yet been determined.

Validation of a new antiserum directed towards the synthetic c-terminus of the FOS protein in avian species: immunological, physiological and behavioral evidence.

In the past 10 years, the study of the expression of immediate early genes, such as c-fos, in the brain has become a common method for the identification of brain areas involved in the regulation of specific physiological and behavioral functions. The use of this method in avian species has been limited by the paucity of suitable antibodies that cross-react with the FOS protein in birds. We describe in this paper the preparation of an antibody directed against a synthetic fragment of the protein product of the c-fos gene in chickens (Gallus domesticus). We demonstrate that this new antibody can be used in several avian species to study FOS expression induced by a variety of pharmacological, physiological and behavioral stimuli. Western blot studies indicated that this antibody recognizes a protein of the expected size (47 kDa) but also cross reacts to some extent with proteins of lower molecular weight that share sequence homology with FOS (Fos-related antigens). FOS immunocytochemistry was performed with this antibody in four species of birds in three different laboratories utilizing diverse variants of the immunocytochemical procedure. In all cases the antibody provided a reliable identification of the FOS antigen. The new antibody described here appears to be suitable for the study of FOS expression in several different avian species and situations. It is available in substantial amounts and will therefore make it possible to use FOS expression as a tool to map brain activity in birds as has now been done for several years in mammalian species.

Screw fixation of a complete rotator cuff tear.

Partial and sometimes full-thickness rotator cuff tears can be managed by arthroscopic debridement and anterior acromioplasty. The recent literature on shoulder arthroscopy does not however mention any alternative operation techniques for this very common lesion. We present a case of a distal avulsion of the supraspinatus vendar tendon which was reattached with one screw and washer under arthroscopic control. Indications for this type of fixation are discussed.

Paralysis of the peroneal nerve following hip fracture treatment.

A prospective study was performed over a period of 2 years to identify the cause of peroneal palsy following hip fracture treatment. Sixty-eight patients in Group I had their injured leg placed in traction in a splint with a metal frame. In Group II (66 patients) elevation only of the fractured extremity was maintained with a few pillows. There were five cases of peroneal palsy in Group I and none in Group II. The difference is significant. Direct pressure on the nerve in the area of the fibular head during the preoperative traction period seems to be the cause of this transient dysfunction.

Three cases of femoral head fracture in a single car accident.

Three cases of femoral head fractures in a single car accident are described. The outcome of these relatively uncommon fractures after 14 months of followup is fair for the Pipkin Type I and II lesions and good for the Pipkin Type IV one. A review of consulted literature has been added.

The rate of recurrence of traumatic anterior dislocation of the shoulder. A study of 154 cases and a review of the literature.

We have reviewed the history of 154 primary, traumatic dislocations of the shoulder in order to determine the risk of recurrence. We found a recurrence rate of 68% in patients under the age of 20, after a follow-up period of 1-9 years (average 4.5 years). There was a highly significant difference (p < 0.0001) in the recurrence rate of patients under, and above, 30 years of age. Twenty per cent of the patients had a concurrent minor fracture at the shoulder with 2 out of 39 of the recurrent cases (5%) and 29 of the 115 non-recurrent cases (25%); this is also a significant difference (p < 0.01). Neither the need for general anaesthesia at primary injury nor the occupation of the patient was a relevant factor in the final outcome of the dislocation. Four nerve injuries were encountered (3%), with no severe sequelae at follow-up. The young patient with no concurrent fracture at the time of the primary shoulder dislocation has a high risk of recurrence.

Isoelastic arthroplasty of the metacarpophalangeal joints in rheumatoid arthritis: a preliminary report.

The Isoelastic prosthesis for the metacarpophalangeal joint was used in 68 rheumatoid joints. The average follow-up period was 3 years and 3 months. The subjective score for pain, appearance, and usefulness as well as the functional outcome was determined by means of a modified Green test. All subjective scores improved postoperatively, whereas function did not change significantly. Preoperative range of motion values were not available. The extension deficit after operation was 26 degrees, the average flexion 63 degrees, and the total range of motion 37 degrees. Grip strength improved only slightly. Complications included four cases of delayed wound healing and four metacarpal fractures after operation. The Isoelastic prosthesis gives satisfactory results in rheumatoid arthritis patients. The intraoperative insertion is easy and the material is well tolerated. In vivo, the implant itself is rigid enough to resist ulnar drift, although osteolysis around the plastic surface has caused recurrence of ulnar deformity.

Blocking B7 and CD40 co-stimulatory molecules decreases antiviral T cell activity.

Inhibition of co-stimulatory signals for T cells by interrupting CD80/CD86-CD28 and CD40-CD154 interactions is a promising approach to prevent transplant rejection and to induce graft tolerance. However, this tolerizing treatment might affect T cell reactivity towards all the antigens to which the immune system is exposed during treatment. We addressed the question whether such inhibition of co-stimulatory ligands on human antigen presenting cells (APC) would affect T cell reactivity against a virus. This was tested in an in vitro system with freshly isolated human monocytes transduced with adenovirus (ad) containing either murine interferon-gamma (mIFN-gamma) or green fluorescent protein (GFP) as marker transgene. T cells co-cultured with transduced monocytes proliferated and produced cytokines. These 'primed' T cells had strong antiviral activity as they subsequently killed ad/GFP-transduced monocytes and reduced mIFN-gamma accumulation in coculture with ad/mIFN-transduced monocytes. However, if priming had occurred in the presence of blocking anti-CD40/CD80/CD86 MoAbs, generation of this antiviral activity was completely prevented. Moreover, T cells primed in the absence of co-stimulatory cells failed to proliferate upon restimulation with adenovirus-transduced monocytes. The results confirm that co-stimulatory signals from APC are required for efficient induction of antiviral T cell activity and point to a potential infectious risk of blocking co-stimulatory signals.

Blocking CD40 - CD154 and CD80/CD86 - CD28 interactions during primary allogeneic stimulation results in T cell anergy and high IL-10 production.

Although CD28 triggering provides an important co-stimulatory signal to T cells, blocking the CD80/CD86 - CD28 interaction with CTLA-4lg fusion protein is not sufficient for tolerance induction in vivo or in vitro. According to more recent data, interruption of the CD40 - CD154 interaction might complement the effect of CTLA-4lg and induce graft acceptance. We studied the effects of a blocking anti-CD40 monoclonal antibody (mAb) and/or blocking anti-CD80/anti-CD86 mAb in cultures of human peripheral blood mononuclear cells (PBMC) stimulated with allogeneic PBMC. T cells activated by alloantigens in the presence of anti-CD80, anti-CD86 and anti-CD40 entered a state of alloantigen-specific non-responsiveness as evidenced upon restimulation by lack of proliferation, cytotoxic activity, and IL-2, IL-5 and IL-13 production. IFN-gamma production during restimulation was less than in the control cultures, while the production of IL-10 was enhanced. Addition of recombinant IL-2 during the restimulation rescued alloantigen-specific activity. We conclude that the simultaneous blocking of the CD40 - CD154 and CD80/CD86 - CD28 interaction during allogeneic T cell activation induces T cell anergy. Since anergic cells induced by this treatment still produce high levels of IL-10, the latter could contribute to modulation of antigen-presenting cell activity and to bystander suppression of residual reactive T cells.

Inhibition of costimulation allows for repeated systemic administration of adenoviral vector in rhesus monkeys.

Immunogenicity of recombinant adenoviral (Ad) vectors severely hampers the clinical development of gene therapy protocols using repeated vector administrations. Inhibition of costimulation by APCs was explored as a strategy to circumvent the immune response against Ad particles. This strategy was tested in rhesus monkeys, treated transiently with chimeric anti-human CD40 and anti-human CD86 antagonist monoclonal antibodies (MAbs) at the time of systemic administration of a recombinant Ad vector. After Ad vector administration in the absence of immunosuppressive treatment, transgene expression in the serum lasted about 3-4 weeks. All control animals developed a strong neutralizing antibody (NAb) response to the Ad particles, which totally prevented efficient administration of a second vector, as shown by the lack of transgene expression. Treatment with anti-CD40 and anti-CD86 chimeric MAbs delayed or blocked the development of a humoral response against Ad and the infiltration of CD8(+) lymphocytes into the liver. This resulted in (i) increased persistence of Ad-transduced cells after injection of a first vector encoding a nonimmunogenic transgene, and (ii) the possibility of readministering a second Ad vector with significant efficacy. In both respects, the combined blockade of CD40 and CD86 was more efficient than treatment with anti-CD40 alone. This study shows for the first time in non-human primates that blocking CD40 and CD86 costimulatory molecules represents a promising strategy to inhibit immune responses against an Ad vector injected systemically.